Provider Demographics
NPI:1962677708
Name:FOWLER, JASON LEE (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LEE
Last Name:FOWLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3099 BRECKENRIDGE LN STE 107
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2120
Practice Address - Country:US
Practice Address - Phone:502-963-5229
Practice Address - Fax:502-963-5365
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6464207OtherCIGNA PROVIDER ID NUMBER
6830783OtherUNITED HEALTHCARE PROVIDER ID NUMBER
KY7100642510Medicaid
CS2003600562OtherCARESOURCE PROVIDER ID NUMBER
IN300033296Medicaid
000001332483OtherANTHEM PROVIDER ID NUMBER
KY2143551OtherWELLCARE OF KY PROVIDER ID NUMBER
KYPDZ000000455121OtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER